Iron supplementation of iron‐replete Indonesian infants is associated with reduced weight‐for‐age

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Abstract
Background: General iron supplementation to prevent iron deficiency in infants who are iron sufficient when starting supplementation may adversely affect their health. Objective: A secondary analysis to explore the effect of iron supplementation on iron‐replete (IR; Hb ≥113 g/L and S‐ferritin ≥33 μg/L) or non‐iron‐replete 6‐month‐old Indonesian infants participating in a large, randomized trial on iron and zinc supplementation. Results: Among the iron‐supplemented IR (Fe‐IR, n = 80) infants S‐ferritin was, compared to non‐iron‐supplemented (NS) IR infants (NS–IR, n = 74), significantly higher (47.5 vs. 20.7 μg/L, p = 0.04), and S‐zinc significantly lower (9.7 vs. 10.5 μmol/L, p = 0.04). Haemoglobin concentration (Hb) did not differ between the Fe‐IR and NS–IR groups. Change in weight‐for‐age z‐score (WAZ) from 6 to 12 months and mean WAZ at 12 months was lower in the Fe‐IR group compared to the NS‐IR group (−1.45 vs. −1.03, p < 0.001 and −1.97 vs. −1.60, p < 0.001, respectively). There was no difference in morbidity between groups. Iron supplementation of non‐iron‐replete infants increased Hb and S‐ferritin, but did not affect S‐zinc or anthropometrical indices. Conclusion: In our study, iron supplementation of IR infants affected WAZ adversely, whereas iron supplementation to non‐iron‐replete infants did not affect growth. These results support a cautious approach to iron supplementation of IR infants.